Indonesia, like many rapidly ageing lower-middle-income countries (LMICs), tends to portray older citizens as 'vulnerable' and 'dependent'; yet the country has few public policies to support them. To this discourse, an alternative stereotype is emerging, influenced by notions of 'successful ageing', which promotes models of older people as healthy and contributing to families and the nation state. In this article, we argue that both stereotypes ignore the varied and context-specific conditions of later life. Importantly, the dominant representations ignore the frailty and dependence that many people in LMICs experience towards the end of their lives. This results in dependence and frailty being concealed from view and treated as a purely familial responsibility, which households living in economic, social and demographic precarity can ill afford. 'Familism by default' spells invisible, unsupported and unsustainable care for many older Indonesians. This article draws on ethnographic fieldwork between 2018 and 2022 from two research projects on ageing, livelihoods, vulnerability and care in disparate communities across Indonesia. By juxtaposing dominant representations with the social, economic and health realities in which lives are lived, we trace the implications for policies, values and practices around care in later life.
BACKGROUND: Subjective cognitive decline (SCD) is recognized as a risk stage for Alzheimer's disease (AD) and other dementias, but its prevalence is not well known. We aimed to use uniform criteria to better estimate SCD prevalence across international cohorts. METHODS: We combined individual participant data for 16 cohorts from 15 countries (members of the COSMIC consortium) and used qualitative and quantitative (Item Response Theory/IRT) harmonization techniques to estimate SCD prevalence. RESULTS: The sample comprised 39,387 cognitively unimpaired individuals above age 60. The prevalence of SCD across studies was around one quarter with both qualitative harmonization/QH (23.8%, 95%CI = 23.3-24.4%) and IRT (25.6%, 95%CI = 25.1-26.1%); however, prevalence estimates varied largely between studies (QH 6.1%, 95%CI = 5.1-7.0%, to 52.7%, 95%CI = 47.4-58.0%; IRT: 7.8%, 95%CI = 6.8-8.9%, to 52.7%, 95%CI = 47.4-58.0%). Across studies, SCD prevalence was higher in men than women, in lower levels of education, in Asian and Black African people compared to White people, in lower- and middle-income countries compared to high-income countries, and in studies conducted in later decades. CONCLUSIONS: SCD is frequent in old age. Having a quarter of older individuals with SCD warrants further investigation of its significance, as a risk stage for AD and other dementias, and of ways to help individuals with SCD who seek medical advice. Moreover, a standardized instrument to measure SCD is needed to overcome the measurement variability currently dominant in the field. ; Susanne Röhr was supported by the LIFE—Leipzig Research Center for Civilization Diseases, University of Leipzig, funded by the European Social Fund and the Free State of Saxony (grant number LIFE-103 P1). This work was further supported by a grant from the Hans and Ilse Breuer Foundation. Funding for COSMIC comes from a National Health and Medical Research Council of Australia Program Grant (ID 1093083) (PSS, HB), the National Institute On Aging of the National Institutes of Health under Award Number RF1AG057531 (PSS, MG, RBL, KR, KWK, HB), and philanthropic contributions to The Dementia Momentum Fund (UNSW Project ID PS38235). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders. Funding for each of the contributing studies is as follows: ActiveAging: no funding; CFAS: major awards from the Medical Research Council and the Department of Health, UK; EAS: Supported in part by National Institutes of Health grants NIA 2 P01 AG03949, the Leonard and Sylvia Marx Foundation, and the Czap Foundation; EPIDEMCA: French National Research Agency (ANR-09-MNPS-009-01); ESPRIT: Novartis; Invece.Ab: Financed with own funds and supported in part by "Federazione Alzheimer Italia", Milan, Italy (AG); KLOSCAD: the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea [Grant No. HI09C1379 (A092077)]; LEILA75+: the Interdisciplinary Centre for Clinical Research at the University of Leipzig (Interdisziplinäres Zentrum für Klinische Forschung/IZKF; grant 01KS9504); LRGS-TUA: Ministry of Education Longterm Research Grant Scheme (LRGS/BU/2012/UKM–UKM/K/01); MAAS: The Netherlands Organization for Scientific Research (NOW). Grant Number: 002.005.019; MoVIES: Grant # R01AG07562 from the National Institute on Aging, National Institutes of Health, United States Department of Health and Human Services; PATH: National Health and Medical Research Council of Australia grants 973302, 179805, 157125 and 1002160; SGS: JSPS KAKENHI Grant Number JP17K09146; SLASII: The SLAS2 study was supported by research grants from the Agency for Science Technology and Research (A*STAR) Biomedical Research Council (BMRC) https://www.a-star.edu.sg/ [Grants 03/1/21/17/214 and 08/1/21/19/567] and the National Medical Research Council http://www.nmrc.gov.sg/ [Grant: NMRC/1108/2007]; ZARADEMP: Supported by grants from the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain (grants 94/1562, 97/1321E, 98/0103, 01/0255, 03/0815, 06/0617, G03/128), and the Fondo Europeo de Desarrollo Regional (FEDER) of the European Union and Gobierno de Aragón, Group #19.
